KDE IEP
IEP Guidance Document Sample
Individual Education Program (IEP)
Kentucky County Public Schools
500 Main Street
Riverview, KY 40000
Meeting Date:
05/15/12
Special Ed Status:
Start Date:
05/15/12
Active
Plan Information
End Date: 05/14/13
Special Education Setting: 40-80% of day in general ed.
program
Primary Disability: Visual Impairment
Student Information
Student Name: Rachel Lucinda Martinez
DOB: 1/1/96
Student Number: 123456
Address: 101 South High Street, Riverview District of Residence: Kentucky County
40000
School of Attendance: Kentucky County
Grade:
Gender: Race (Ethnicity Code):
High School
10
F
Hispanic
Present Level of Academic Achievement and Functional Performance
Present Levels of Academic Achievement and Functional Performance, including how the disability
affects the student’s involvement and progress in the general curriculum:
(For preschool children include the effect on participation in appropriate activities; Beginning in the
child’s 8th grade year or when the child has reached the age of 14, a statement of transition is included.)
Communication Status
Performance commensurate with similar age peers
Academic Performance
Performance commensurate with similar age peers
According to the Re-evaluation Report dated 5/3/2012, progress monitoring, curriculum assessment,
work samples, and teacher observations, Rachel’s basic reading and listening comprehension are in the
average range. She demonstrates average to above average writing abilities on class assignments,
research projects, formal and informal assessments.
Given standardized math assessments (PLAN and Kaufman Test of Educational Achievement, Second
Edition), summative and formative assessment, analysis of work samples, and teacher observation,
Rachel’s math calculation and math reasoning skills are well below average. Given the impact of her
visual impairment, Rachel struggles to reason abstractly and quantitatively. She struggles to visualize
graphical representation of complex math concepts. She struggles to visualize complete math
expressions in their entireties. Rather, she focuses on small segments of a problem rather than whole.
When presented with a novel math concept such as
various functions, she does not make connections with previous learning. She quickly applies a known
rule or routine and attempts to calculate a response. She does not make sense of the quantities, exploring
strategies or alternate solutions (e.g., consider representations of the problem, consider related problems,
consider simpler forms of the problem, or refer to previously completed example problems). Rachel
requires teacher modeling and numerous practices to master a concept and specific instruction to
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KDE IEP
IEP Guidance Document Sample
generalize and apply concepts to real world situations. Error analysis of classwork and homework reveal
that Rachel chooses an appropriate math strategy with 60% accuracy. She solves math equations for
linear and quadratic equations with 30% accuracy. While Rachel efficiently uses a graphing calculator to
complete a computational problem (90% accuracy), she struggles to construct a graphic representation of
an absolute
value function such as determining the output from the domain (40% accuracy). Rachel uses a variety of
low vision supports during math class including magnification for the graphing calculator, raised line
paper and graph paper. To develop an understanding of math concepts, she needs concrete experiences
such as models, manipulatives, and life items. According to teacher report and class observation, Rachel
rarely volunteers during class discussion or asks clarifying questions, but she will seek teacher assistance
before or after school. Deficits in math calculation and reasoning impact performance in math class,
homework assignments, in classes requiring math applications and in real world scenarios.
Health, Vision, Hearing, Motor Ability
Performance commensurate with similar age peers
According to an eye medical examination dated 2/15/12, Rachel has a visual diagnosis of Retinopathy of
Prematurity (ROP), which limits blood vessel development in premature infants that can lead to bleeding,
scarring, and retinal detachment. Rachel’s secondary diagnosis is myopia which is a refractive error of
nearsightedness. Rachel’s distance visual acuity with best correction is 20/400 in her right eye and
20/200 in her left eye. She wears glasses at all times. Her full field of vision is approximately 70-80
degrees with both eyes. (A normal field of vision is 180 degrees.) The eye report states that Rachel is
legally blind due to acuity and a constricted field of view and further states that Rachel’s visual prognosis
is considered uncertain at this time.
Rachel is under the care of a neurologist, because she experiences migraine headaches infrequently
(approximately once a month). In the event of a migraine, Rachel reports that she is unable to read print
passages and complete written assignments. Rachel has a Health Plan on file related to her migraines.
Orientation & Mobility: Rachel uses a long white cane for travel in unfamiliar indoor areas and when
traveling outdoors to compensate for her visual field loss and decreased visual acuity. A relative strength
is that she travels independently inside familiar environments including school and her immediate
neighborhood (90% accuracy) as measured by her Orientation and Mobility Specialist. A relative
weakness is independent travel experience in unfamiliar environments within the community. She is
making progress in street crossings at lighted intersections, however she continues to need adult prompts
to determine when it is safe to cross (independent street crossing 80% in 10 trials). She has been
introduced to route planning using the city’s numbering system (20% accuracy) and map reading (20%
accuracy). She needs further instruction in independent street crossing at lighted intersections, route
planning using the city’s numbering system, and map reading. Rachel’s restricted visual field, decreased
visual acuity and lack of community travel experience negatively impact her ability to travel safely and
independently across settings.
Social and Emotional Status
Performance commensurate with similar age peers
General Intelligence
Performance commensurate with similar age peers
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IEP Guidance Document Sample
Transition Needs
Not an area of concern at this time (Checking this box is not an option when the student is in the 8th
Grade or 14 years or older because transition must be addressed for these students)
Instruction
Related Service
Community Experience
Employment
Daily Living Skills
Post School Adult Living Objectives
Functional Vocational Evaluation
Rachel is a 16 year old 10th grader. She is scheduled to graduate in May of 2014 with a diploma as
documented in her Multiyear Course of Study. As a 10th grader she has completed required coursework
and she is on track for graduation within four years. Rachel demonstrates good work habits including
timely assignment completion, organization of notes and study materials and equipment, and frequent
participation in class discussion. She works well in a group. She is a member of the newspaper and
yearbook staff.
The following information is gained from Rachel’s Individual Learning Plan, Transition Survey, Student
Interview and Career Scope:
 Rachel wants to attend a 4-year college starting initially at KY Community and Technical College
(KCTC).
 Rachel wants to work as a writer, perhaps for a radio or television station.
 Rachel works well in a group, but she prefers to complete independent tasks in a quiet
environment.
 Rachel has an interest and talent in vocal music.
Rachel demonstrates Transition Needs in four areas: Instruction, Related Services, Community
Experiences and Employment.
Transition Needs: Instruction
Reading and written language are areas of strength for Rachel. Progress monitoring, classroom
assessment and standardized assessment identify significant challenges in math, particularly math
reasoning (see baseline data in the Academic Performance section above). Deficits in math impact
successful completion of high school coursework (math, science) and potentially math requirements in
the college setting.
Braille is a relatively new area of instruction for Rachel and she is making satisfactory progress in code
recognition (see baseline data in the Functional Vision Learning Media Assessment section). Future skill
development is warranted for code recognition, code rules, reading fluency and Braille writing. Rachel
needs continued instruction in Braille to provide alternate media to print given her uncertain visual
prognosis and difficulties with vision when experiencing migraines.
When given adapted materials or equipment in a small group setting, Rachel successfully uses the
adapted materials and equipment. She requires adult assistance to identify and access reading materials
for school use and for leisure reading. Rachel is hesitant to make requests for accommodations or
assistance in school (large group) and the community for fear of drawing attention to her eye condition
(see baseline data in the Functional Vision/Learning Media Assessment section). Accessing materials
and self-determination skills are fundamental to Rachel’s successful transition to college and career.
Deficits in materials access and self-determination will negatively impact Rachel’s ability to function
independently across high school settings, a college campus and in employment settings.
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IEP Guidance Document Sample
Transition Needs: Related Services
While Rachel is an independent traveler on the high school campus, she requires orientation to new
settings (see baseline data in the Health, Vision section). She needs continued instruction for
independent traveling within the community, for participation in extracurricular activities, for future
employment and college campus travel.
Decreased visual acuity and loss of visual field adversely affects Rachel’s ability to travel safely and
independently in unfamiliar environments.
Transition Needs: Community Experience
According to her Individual Learning Plan (ILP) and the Functional Vision/Learning Media Assessment,
Rachel’s community experience is limited to her high school friends and high school programming. In
order to successfully transition to college and career preparation, she needs an introduction to adult
services, as well as community and college opportunities (baseline 0% for adult service awareness).
Rachel has a picture identification card from her high school, yet no other form of picture identification
which is needed for community volunteer opportunities, employment, and college enrollment. She
needs a state identification card. Rachel will benefit from an exploration of services offered by the
Office for the Blind. Further, Rachel needs to explore participation in community and college programs
that provide post-secondary supports and opportunities (e.g., volunteer opportunities, leisure activities,
college, career, and work experiences). A limited awareness of community and college opportunities and
adult services can negatively impact Rachel’s successful post-secondary transition.
Transition Needs: Employment
Given strengths in written language, Rachel is interested in a career in writing in television or radio (see
Individual Learning Plan—ILP). She attributes this employment interest to a recent television
documentary highlighting an individual with a disability employed as a television writer. At present, she
has limited awareness of careers for writers. She will benefit from research in careers related to writing.
Rachel may gain insight to employment opportunities given the opportunity to network with an adult
mentor who is blind/visually impaired and employed in the writing field. Rachel is interested in
exploring the various ways colleges offer coursework including campus based class versus web-based
classes. In total, Rachel has limited knowledge of college training options and employment
opportunities. This narrow understanding may negatively impact her successful transition to college
enrollment and completion and career exploration.
Functional Vision/Learning Media Assessment
Not an area of concern at this time
In a Functional Vision/Learning Media Assessment (FVLMA) dated April 16, 2012, Rachel’s primary
medium is print with her auditory channel as secondary. She identifies 12-14 point size standard print,
bold, black, isolated letters on a white background at a distance of 4-6 inches. Rachel copies 2-3 inch
size letters from the board when sitting at a distance 10 feet. Due to her visual acuity and visual field
loss, Rachel prefers to sit on the right side of the room when copying materials from the board.
Compensatory or Functional Academic Skills, Including Communication Modes:
Rachel requires high contrast materials. She prefers materials that are written in 16-18 point print size
using a yellow overlay. Given the results of an informal reading inventory, Rachel reads independently
on 10th grade passage when using large print and colored overlays. Rachel’s silent reading rate is 115
words per minute (wpm) with adaptations. The average silent reading rate for students with normal
vision at 10th grade is 210-224 wpm. As the passage length increases, Rachel’s reading speed decreases.
Thus, Rachel needs extended time and short 1-2 minute breaks when reading lengthy assignments
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IEP Guidance Document Sample
(greater than 20 minutes) or an auditory output option. The results of a listening comprehension
assessment indicate that Rachel performs at the independent level at grade 10. She uses a typoscope
(signature guide) for signing her signature.
Rachel has participated in Braille instruction for the past year. Given progress monitoring results, Rachel
mastered 100% of whole word signs, 53% of short form words, and 50% of part word signs in reading
and writing in Literary Braille. She enjoys Braille instruction and prefers to select her own reading
materials. Rachel is proficient in the use of the Braille writer. Rachel needs continued instruction in
Braille due to the nature of Retinopathy of Prematurity and prognosis of her eye condition.
Use of Assistive Technology:
Rachel benefits from electronic text and/or auditory output of text for lengthy reading passages. Rachel
demonstrates good basic computer skills using built in accessibility features. Following keyboarding
instruction in 10th grade, she is able to prepare assignments via word processing. She types 20 words per
minute. Rachel’s handwriting is legible. She needs bold-lined paper, bold-lined graph paper and
additional writing space. She prefers that writing on a white board be blue or black print to provide a
greater contrast. Progress monitoring data indicate proficiency in the use and maintenance of technology
and equipment (100% on 5/5 occasions). Rachel prefers large print on worksheets and handouts (16-18
points). She benefits from a bar magnifier, hand held video magnifier or desktop Closed Circuit TV
(CCTV) for reading material when enlarged copies are not available. Rachel is a proficient user of the
hand held video magnifier and desktop CCTV. Rachel benefits from a reader when completing material
under time constraints or when longer passages are presented as her eyes fatigue and reading rate become
slower. Rachel requires a scribe for transferring answers to an electronic answer sheet (bubble sheet).
Sensory Efficiency Skills:
Rachel is learning Braille as a secondary medium. She demonstrates good tactual skills and is making
progress in Braille instruction (see discussion in Compensatory in Functional Academic section). When
asked about a vision device needed for a given task, she selects and uses an appropriate device (see
discussion in Self-Determination).
Self-Determination:
Currently, teaching staff provides all of Rachel’s educational materials including textbooks and adapted
materials. An essential skill for college and career readiness is independently accessing reading materials
from various resources. At present, she is not familiar with accessing print or auditory materials for
educational purposes (0% proficiency). Per progress monitoring data, Rachel requires prompting to
explain her eye condition and request needed adaptations in the classroom setting (3/3 occasions).
Rachel needs continued development of self-advocacy skills to inform others about her eye condition and
to independently access modifications and accommodations.
Of the 9 areas of Expanded Core Curriculum, the following areas are not areas of concern at this time:
Social Interaction Skills, Independent Living Skills, Recreation and Leisure Skills. Orientation and
Mobility is discussed under the Health, Vision, and Motor Abilities section. Career Education is
discussed under the Transition Needs section of the IEP.
Competence in reading and writing in Braille, accessing reading materials for classes and leisure reading,
educating others about her eye condition and identifying needed accommodations across settings
negatively impact Rachel’s independence in the school and community.
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IEP Guidance Document Sample
Consideration of Special Factors for IEP Development
(The ARC must address each question below and consider these issues in the review and revision of the
IEP)
Does the child’s behavior impede his/her learning or that of others?
Yes
No
If Yes, include appropriate strategies, such as positive behavioral interventions and supports in the
statement of device and services below.
Does the child have limited English proficiency?
Yes
No
If Yes, what is the relationship of language needs to the IEP?
Is the child blind or visually impaired?
Yes
No If Yes, the team must consider:
 Is instruction in Braille needed?
Yes
No
 Is use of Braille needed?
Yes
No
 Will Braille be the student’s primary mode of communication?
Yes
No
 (See evaluation data for supporting evidence)
Does the child have communication needs?
Yes
See Present Levels for Communication Status
Other (Specify):
No
Is the child deaf or hard of hearing?
Yes
No
 The child’s language and communication needs; Describe:
See Present Levels for Communication Status
Other (Specify):
If Yes, please specify below:
If Yes, the team must consider:

Opportunities for direct communications with peers and professional personnel in the child’s
language and communication mode, academic level and full range of needs; Describe:

Any necessary opportunities for direct instruction in the child’s language and communication
mode. Describe:
Are assistive technology devices and services necessary in order to implement the child’s IEP?
Yes
No
If Yes, include appropriate devices in the ‘Statement of Devices/Services’ below.
Statement of Devices/Services: If the ARC answered Yes to any of the above, include a statement of
services and or devices to be provided to address the above special factors.
See Specially Designed Instruction
See Supplemental Aids and Services
See Behavior Intervention Plan
Other (Specify):
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IEP Guidance Document Sample
Measurable Annual Goals and Benchmarks
Annual Measurable Goal (#1):
Given 10 math reasoning problems requiring the application of varying mathematical strategies weekly,
Rachel will analyze the problem, consider options for expression, create a representations of the problem
with 80% accuracy in 4/5 consecutive work samples.
Method of Measurement:
Indirect: Work Samples, Rubric
Direct: Observation
Specially Designed Instruction:
Review of previously learned mathematical strategies for application and generalization
Instruction in creating varied representations of a problem
Instruction in creating and using models, manipulatives and real life experiences to express a problem
Instruction in matching mathematical strategies to individual math problem
Instruction in a step by step process for solving equations (e.g., analysis, conjecture, solution generation;
consideration of analogous problems, monitor, evaluate, adjustment)
Instruction in identifying alternate approaches for solving an equation
This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the
area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. Rachel will identify the varying types of representations to communicate the meaning of a given
problem in 4/5 consecutive work samples.
2. Given alternate approaches and strategies in solving equations, Rachel will choose the
appropriate strategy.
3. Rachel will identify and apply a step by step process for solving an equation.
4. Rachel will solve equations using varied mathematical strategies.
Annual Measurable Goal (#2):
Given a 50 word grade level passage written in contracted Braille with short form words, part-word
signs, and Dot 5 words, Rachel will tactually decipher the rules of the Braille code and read the passage
aloud with 90% accuracy on 4/5 occasions.
Method of Measurement:
Indirect: Work samples
Direct: Checklist
Specially Designed Instruction:
Direct instruction Braille rules of short form words, part-word signs, Dot 5 words
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This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the
area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. Rachel will tactually read sentences with short form words.
2. Rachel will tactually read sentences with part-word signs.
3. Rachel will tactually read sentences with Dot 5 words.
Annual Measurable Goal (#3):
Given a 50 word grade level passage, Rachel will write the passage in the contracted Braille code using
short form words, part-word signs, and Dot 5 words with 90% accuracy on 4/5 occasions.
Method of Measurement:
Indirect: Work samples
Direct: Checklist
Specially Designed Instruction:
Direct instruction Braille rules of short form words, part-word signs, Dot 5 words
This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the
area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. Rachel will write sentences using short form words.
2. Rachel will write sentences using the part-word signs.
3. Rachel will write sentences using Dot 5 words.
Annual Measurable Goal (#4):
Given an assignment to use specific classroom textbooks or materials, Rachel will independently
research resources or potential vendors, locate the desired material and download or prepare an order
with 80% accuracy 3/4 occasions.
Method of Measurement:
Indirect: Checklist, Work sample
Specially Designed Instruction:
Direct instruction in accessing alternate formats of text, scanning products and placing an order.
This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the
area(s) of:
Education/training
Employment
Benchmarks/Short Term Instructional Objectives
Independent living
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IEP Guidance Document Sample
1. Given computer/internet access to research available format of texts, Rachel will locate textbooks
for each high school class using the course description, and ISBN number of text.
2. Rachel will use a computer and Internet to download textbooks or novels in digital format.
3. Rachel will use a computer and Internet to prepare an order for materials (e.g., large print, ASCII)
Annual Measurable Goal (#5):
Given formal and informal opportunities, Rachel will independently educate others about her eye
condition and identify needed accommodations for a given setting with 80% accuracy on 5/6 occasions.
Method of Measurement:
Indirect: Checklists, rubric, work samples
Specially Designed Instruction:
Direct instruction in understanding her eye report and IEP
Direct instruction in self-advocacy strategy
This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the
area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. Rachel will identify and access accommodations for a structured classroom situation.
2. Rachel will identify and access accommodations for a non-structured setting (e.g., assembly,
yearbook staff activity, library research)
3. Rachel will prepare a presentation explaining her vision condition and post-secondary goals for
her next IEP meeting (e.g., Power Point, handout, brochure).
4. Given school visits from universities and colleges, Rachel will prepare questions and inquire
about disability supports.
Annual Measurable Goal (#6):
When traveling in unfamiliar territories, Rachel will demonstrate 4/4 steps to safely and independently
cross the street at lighted intersections over 3 consecutive lessons.
Method of Measurement:
Direct: Checklist
Specially Designed Instruction:
Direct instruction in recognition of traffic patterns and traffic movement, structure of intersections
Direct instruction in the use of long white cane
Direct instruction in use of enlarged maps
This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the
area(s) of:
Education/training
Employment
Independent living
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Benchmarks/Short Term Instructional Objectives
1. Rachel will identify/distinguish parallel and perpendicular traffic surges.
2. Rachel will identify intersection shape (T, plus, Y, offset).
3. Rachel will correctly analyze traffic patterns & identify turning cars.
Annual Measurable Goal (#7):
When presented with the task of locating an unfamiliar destination, Rachel will utilize the city’s
numbering system and an enlarged map to safely and independently plan, travel and locate the
destination with 90% accuracy on 4/4 occasions.
Method of Measurement:
Direct: Checklist
Specially Designed Instruction:
Direct instruction in community numbering system
Direct instruction in use of enlarged maps
This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the
area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. Rachel will locate the central dividing line for north/south and east/west streets on an enlarged
map.
2. Rachel will distinguish odd and even sides of the street.
3. Rachel will locate specific destinations by address.
Reporting Progress
Concurrent with the issuance of Report Cards
Other, specify
Supplementary Aids and Services
Statement of Supplementary Aids and Services, to be provided to the child on behalf of the child.
Long white cane
Large print materials
Bold-lined paper with glare reduction, bold-lined graph paper
High contrast materials, yellow overlays or typoscope
Use of blue or black print “only” for white board presentations
Braille reading materials
Bar magnifier, hand held video magnifier or desktop CCTV when large print materials are not available
Electronic text and/or auditory output
Graphing calculator with low vision device
Reader in the event that auditory output of text is not available
Scribe for electronic answer sheet (bubble form)
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IEP Guidance Document Sample
Computer with internet access
Preferred seating at the right side of the classroom for demonstrations, presentations and copying
materials from the board
The ability to move about the classroom for best viewing
Extended time for assignments involving reading and writing
Short break (1-2 minutes) during reading periods of greater than 20 minutes
Fading verbal prompts/cues
Accommodations for Administration of State Assessments and Assessments in the Classroom
In order to justify appropriateness of accommodations for any state mandated tests, the testing
accommodations must be used consistently as part of routine instruction and classroom assessment as
well as meet all additional requirements established by the Inclusion of Special Populations in the
State-Required Assessment and Accountability Programs,703 KAR 5:070 document.
ARC determined no accommodations needed.
Readers
Scribes
Paraphrasing
Reinforcement and behavior modification strategies
Prompting/cueing
Use of technology
Manipulatives
Braille
Interpreters
Extended time
Other: specify
Rachel needs electronic text or auditory materials, or large print materials with a yellow overlay to
reduce glare if assessment is on white paper. She requires an auditory output of the assessment when
experiencing migraines or eye fatigue. A reader is necessary only when auditory output of text is not
available. A scribe is needed only in the event of an electronic answer sheet (bubble sheet) or migraine.
Student has been determined eligible for participation in the Alternate Assessment Program.
Complete the Participation Guidelines for the KY Alternate Assessment form if selecting this
checkbox. If determined eligible for the Alternate Assessment, the ARC must determine if the
student is Dimension A or Dimension B.
Dimension A
Dimension B
Program Modifications/Supports for school personnel that will be provided
Supports for school personnel:
At the beginning of the year and with any teacher change (trimester schedule), the vision teacher will
provide training for the special education teacher and regular class teachers regarding Rachel’s
Supplementary Aids and Services. The vision teacher will provide monthly consultation sessions with the
special education and regular class teachers regarding implementation of the Supplementary Aids and
Services.
Rachel requires an adult sighted guide for exiting the building during emergency events.
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Not needed at this time
Least Restrictive Environment (LRE) and General Education
Explain the extent, if any, to which the student will not participate in general education (content area):
Special Education: Math, Expanded Core Curriculum (Braille, Self-Determination, Orientation &
Mobility)
Regular Class: English, Social Studies, Science, Electives
Type of
Service
Special Education Services
Anticipated Frequency and Duration of Service
Service
Service
Service
Minutes Frequency
Period
Start
End Date
(Per
(Number
(Daily,
Date
Service
of times
Weekly,
Frequency) provided
Monthly,
per Service Annually)
Period)
50 minutes
Special
Education
1.0
Daily
5/15/12
5/14/13
50 minutes
Special
Education
4 times
Weekly
5/15/12
5/14/13
Type of
Service
Related Services
Anticipated Frequency and Duration of Service
Service
Service
Service
Minutes Frequency
Period
Start
End Date
(Per
(Number
(Daily,
Date
Service
of times
Weekly,
Frequency) provided
Monthly,
per Service Annually)
Period)
Orientation 50 minutes
and
Mobility
Services
1 time
Weekly
5/15/12
5/14/13
Service
Provider
(by
Position)
Location
(e.g., Regular
Classroom,
Resource
Room,
Separate
Class)
Special
Education
Teacher
Teacher
of the
Visually
Impaired
Resource for
Math
Service
Provider
(by
Position)
Resource for
ECC –
Braille, SelfDetermination
Location
(e.g.,
Regular
Classroom,
Resource
Room,
Separate
Class)
Orientation School and
& Mobility Community
Specialist
for O & M
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Extended School Year
Are extended school year services required for this student?
Yes
No
More data needed
If the ARC determines ESY services are to be provided, describe the service and indicate to which
annual goal or goals the service is related. If the ARC determines no ESY services are to be
provided, please document the reason(s) for this decision.
Progress monitoring does not indicate a regression/recoupment delay for Rachel.
Transition Service Needs
(Beginning in the child’s 8th grade year or when the child has reached the age of 14 and thereafter)
What transition assessments were used to determine the child’s preference and interests?
(Check all that apply)
Student Interview
Student Portfolio
Interest Inventory
Career Awareness
ILP
Student Survey
Vocational Assessments
Parent Interview
Career Aptitude
Other:
Does the student’s Individual Learning Plan (ILP) include the student’s course of study?
No If No, do not proceed with development of IEP until ILP is initiated, including the child’s
course of study.
Yes (See student’s attached course of study to include current school year through graduation or
exiting special education)
Do transition service needs focus on child’s course of study and are they addressed in Present
Levels?
No
Yes
Postsecondary Goal(s)
(By age 16, or younger if appropriate, and thereafter)
(Postsecondary Goal(s) Related to Education/Training, Employment, and if needed,
Independent Living:
Education/Training and Employment: Upon graduation from high school, Rachel’s goal is to attend a
community college (KCTC) and major in writing to become a writer for the television or radio industry.




Transition Service
Provide information post-secondary opportunities (e.g., KSB
summer programming, INSIGHT program)
Completion of coursework leading to a diploma.
Provide contact information for the Office for the Blind and
invite representative from OFB to the next annual review.
Contact disability office at KCTC to explore supports (O &
M)
Agency Responsible
 KCHS staff


KCHS Staff
KCHS staff


KCHS staff
KCHS staff
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



Site visit to KCTC
Provide assistance for obtaining State Identification Card
Provide information for accessing a mentor in chosen field of
interest
Career awareness and exploration via the ILP



KCHS Staff
KCHS Staff
KCHS Staff
Transfer of Rights at Age of Majority
If applicable, one year before the student reaches age 18 the student and parent have been informed
of the student’s rights under Part B of the Individuals with Disabilities Education Act, if any, that
will transfer on reaching the age of majority.
Date student was first informed of the transfer of rights:
5/15/12
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